Association of serum adiponectin levels with all-cause mortality in hemodialysis patients

Objective Adiponectin (ADPN) has been shown to protect against cardiovascular disease for the general population with problematic metabolic syndrome. However, it remains unclear whether ADPN is associated with mortality in patients on maintenance hemodialysis (HD). Methods, Patients or Materials We selected 85 HD patients [51 men/34 women; mean age, 64 +/- 2 years; underlying kidney diseases, diabetic nephropathy in 36 patients (42.3%), chronic glomerulonephritis in 29 (34.1%), hypertensive nephrosclerosis in 10 (11.8%), and others in 10 (11.8%)] who survived for more than 3 months after the start of HD. We first measured serum ADPN levels and prospectively followed patients for the next 3 years. Results We were able to follow 74 of 85 patients; 59 survived, and 15 died. Serum log-transformed ADPN levels were negatively correlated with BMI (r=-0.43, p<0.01). Despite a similar BMI (20.7 +/- 0.8 vs. 20.3 +/- 0.4 kg/m(2)), the expired patients had significantly higher ADPN compared with the surviving patients (20.5 mu g/ml [14.0-23.5] vs. 14.2 mu g/ml [9.7-21.3], p<0.05). Cox-hazards multivariate regression analysis adjusted for conventional case-mix features (age, sex, and underlying kidney disease) revealed that serum ADPN became a significant determinant of all-cause mortality. There was a 10.3% risk increment for each 1-mu g/ml increase in ADPN during the follow-up. Kaplan-Meier analysis revealed that patients with higher ADPN levels (>= 15 mu g/ml) had a significantly lower survival rate compared with those with lower ADPN levels (<15 mu g/ml) (76 vs. 92%, p<0.05). Conclusion These results indicated that high rather than low ADPN independently predict total mortality in HD patients.